PUSHPA K MAMTANI MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****64

License Status

ACTIVE

Business

First Name

PUSHPA

Middle

Last Name

MAMTANI

Suffix

Business Name

PUSHPA K MAMTANI MD

Original Issue Date

08/17/2004

Effective Date

06/22/2023

Expiration Date

07/31/2026

City

SYCAMORE

State

Zip

60178

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/22/2023